Low Socioeconomic Areas Research Articles

Corrigendum to: Survey of paediatric telehealth benefits from the caregiver perspective.

Objective This study determined caregivers' evaluations of telehealth consultations for their child, preference over in-person consultations and potential cost savings by child condition, family socioeconomic status and location. Methods A survey was conducted of 2436 caregivers attending a telehealth consultation with their child for a broad group of conditions between 3 June and 25 August 2020 at a tertiary paediatric hospital in Melbourne, Australia. Results Most caregivers found telehealth consultations convenient, acceptable, safe and private, and capable of answering their questions and concerns. However, caregivers who spoke a language other than English and patients attending for behavioural and mental health, developmental or other (e.g. allied health) concerns were more likely to prefer in-person consultations over telehealth. Mean (±s.d.) reported cost savings on caregiver time were A$144.98 ± 99.04 per family per consultation, whereas mean (±s.d.) transport cost savings were A$84.90 ± 100.74 per family per consultation. Cost savings were greatest for families living in low and middle socioeconomic areas and regional or rural areas. Conclusions Paediatric telehealth video consultations were largely viewed favourably by caregivers, except for those attending for behavioural and mental health or developmental concerns. What is known about the topic? Adult consumers of telehealth consultations view them as useful, convenient and cost saving, but less is known about caregivers' evaluations of telehealth consultations and potential cost savings for paediatric patients, and whether these differ by family location, socioeconomic status or child condition. What does this paper add? This is the first Australian paper to report on caregivers' evaluations across a range of paediatric conditions and locations. Most caregivers found telehealth consultations convenient, safe, acceptable, able to answer their questions and concerns about their child's health and cost saving. What are the implications for practitioners? Caregivers of children with behavioural, mental health or developmental problems were less likely to prefer telehealth over in-person consultations, so practitioners should consider providing such consultations in person.

Sociodemographic, anthropometric, and lifestyle correlates of prediabetes and type 2 diabetes in europe: The Feel4Diabetes study

Background and aimsThe current work aimed to identify the predominant correlates of prediabetes and T2DM among a variety of socio-demographic, anthropometric and lifestyle indices, in a large sample of adults from families at high risk for T2DM. Methods and resultsIn this cross-sectional study, 2816 adults were recruited from low-socioeconomic areas in high-income countries (HICs) (Belgium-Finland), HICs under austerity measures (Greece-Spain), and low/middle-income countries (LMICs) (Bulgaria-Hungary). A positive association between the male sex (OR, 95% C.I.2.77 (1.69–4.54)) and prediabetes was revealed compared to females, while there was a negative association between younger age (<45 years) (OR, 95% C.I. 0.58 (0.37–0.92)), and low/medium levels of waist circumference (OR, 95% C.I. 0.44 (0.22–0.89)) with prediabetes compared to older age and high levels of waist circumference, respectively. Concerning T2DM, 0–0.5 cups/day of fruits and berries (OR, 95% C.I.2. 13 (1.16–3.91)) and 150–300 g fish/week (OR, 95% C.I. 2.55 (1.01–6.41)) have a positive association compared to higher consumptions, respectively. Conversely, <1 cup/week legumes (OR, 95% C.I. 0.55 (0.31–0.99) as well as 0–0.5 servings (OR, 95% C.I. 0.34 (0.12–0.95) and 0.5–1 servings (OR, 95% C.I. 0.37 (0.19–0.71) of full-fat dairy/day have a negative association compared to higher consumptions, respectively. ConclusionThese findings indicate the need for diabetes prevention measures targeting young adults and especially men, above 45 years of age, with central obesity and poor dietary habits and prioritize vulnerable groups and populations living in LMICs. National Clinical Trial numberNCT 02393872

Access to Healthy Wheat and Maize Processed Foods in Mexico City: Comparisons across Socioeconomic Areas and Store Types.

The contributions of processed foods to the overweight and obesity problem in Latin America are well known. Engagement with the private and public sectors on possible solutions requires deeper insights into where and how these products are sold and the related implications for diet quality. This article characterizes the diversity of wheat and maize processed foods (WMPFs) available to consumers in Mexico City. Data were gathered across nine product categories at different points of sale (supermarkets, small grocery stores, convenience stores) in high and low socioeconomic (SE) areas. We assessed WMPFs based on Nutri-Score profile, price, and health and nutrition claims. Roughly 17.4% of the WMPFs were considered healthy, of which 62.2% were pastas and breads. Availability of healthy WMPFs was scarce in most stores, particularly in convenience stores Compared to supermarkets in the low SE area, those in the high SE area exhibited greater variety in access to healthy WMPFs across all product categories. In the low SE area, healthy WMPFs were priced 16–69% lower than unhealthy WMPFs across product categories. The extensive variety of unhealthy WMPFs, the limited stock of healthy WMPFs in most retail outlets, and the confusing health and nutrition claims on packaging make it difficult for urban consumers to find and choose healthy WMPFs.

Impact of Socioeconomic Status on Breast Reconstruction Outcomes.

Minority patients and those from low socioeconomic backgrounds are faced with barriers to care regarding breast reconstruction. With this study, we seek to elucidate variances in demographics to determine predictors of complications in implant-based breast reconstruction. Patients who underwent breast reconstruction with either direct to implant or immediate expander reconstruction by 1 surgeon were identified using the preoperative Breast-Q.Current income statistics available from the US Census Bureau by self-reported zip code were used to determine the median household income (MHI) to stratify differing socioeconomic backgrounds. Demographics were compared with body mass index, comorbidities, overall rate of postoperative complications, rate of implant infection, and type of reconstruction. Two hundred ninety-five patients met inclusion criteria. Overall rate of complications and rate of breast implant infection was higher for MHI of less than $50,000 compared with greater than $50,000 (P = 0.043 overall complications 40.20% vs 28.8%) (P = 0.04 implant infection 14.4% vs 7.1%). African American patients had higher body mass index (P = <0.001), rates of HTN (P = <0.001), and diabetes (P = 0.001), and were more likely to have a lower income (P = <0.001). There was, however, no difference in overall complications (P = 0.26), implant infection rate (P = 0.994), or capsular contracture (0.367) based on race. There was no difference in rate of comorbidities between low and high socioeconomic areas. This cohort demonstrates a higher rate of overall complications and infection in patients with a lower MHI and no difference based on race despite having higher risk factors for complications.Socioeconomic status is a multifaceted barrier to care that must be addressed in the perioperative period to decrease breast implant associated complications.

Urban\u2013rural prostate cancer disparities in a regional state of Australia

Men living in regional and remote areas experience disparities in prostate cancer (PrCa) diagnosis, clinical characteristics and treatment modalities. We sought to determine whether such disparities exist in PrCa patients from Tasmania; a regional state of Australia with the second-highest rate of diagnosis and where over a third of residents live in outer regional and remote areas. Our study included clinicopathological data from 1526 patients enrolled in the Prostate Cancer Outcomes Registry-Tasmania. Regression analyses were undertaken to determine whether demographic, clinical and treatment variables differed between inner regional and outer regional/remote patients. Men from outer regional/remote areas were significantly more likely to reside in lower socio-economic areas, be diagnosed at a later age and with more clinically aggressive features. However, in contrast to previous studies, there were no overall differences in diagnostic or treatment method, although men from outer regional/remote areas took longer to commence active treatment and travelled further to do so. This study is the first to investigate PrCa disparities in a wholly regional Australian state and highlights the need to develop systematic interventions at the patient and healthcare level to improve outcomes in outer regional and remote populations in Australia and across the globe.

Knowledge about Obstetrical Danger Signs among Pregnant Women of Low Socioeconomic Class

Background: In many developing countries including Pakistan maternal morbidity and mortality is still high. Knowledge of danger signs of Obstetrics during pregnancy is the first essential step for the timely referral. This study therefore, aims to fill this gap by assessing the current level of knowledge and associated factors of pregnant women living in low socioeconomic areas of Karachi Aim: The aim of the study is to assess the knowledge of pregnant women with low socio-economic status about the obstetric danger signs. Study Design: A cross-sectional study. Place and Duration: Community based medical centers of Gadap Town Karachi, from October 2020 to October 2021. Methods: A total of 300 pregnant women gave their consent and took part in the study. Data was collected in local language by interview and a pre-designed, tested questionnaire was used, which included the socio-demographic profile, number of births, prenatal care visits, and pregnant women knowledge of danger signs during pregnancy, and in the postpartum period. Socio-economic status was assessed in accordance with the modified international classification. Results: Knowledge of at least one danger sign varied from a total of 300 pregnant women consented and took part in this study. Most of them are in the age group of 21-34 years 138(46%) and over 92 (30.7%) were above thirty years, followed by the age group of 18-20 year 70(23.3%) and then &gt;35 years (27%). Most of the pregnant women (62.3%) have completed the primary Level education. The majority of the surveyed population is housewives and semiskilled workers. Conclusions: Our study has shown that there is little knowledge of the danger signs of pregnancy among pregnant women. Also, most subjects are unaware of obstetric danger signs. Based on this study, we suggest that planned strategies are needed to increase women's awareness of obstetric danger signs. Raising awareness of the key signs of danger, creating and promoting mechanisms of generating income should be carried out on a continuous basis in the health facility and in the environment, as it prepares women and their families to make appropriate, quick and effective decisions and actions in the event of symptoms of obstetric emergency. Keywords: Obstetric danger signs, pregnancy Antenatal and postpartum period

Cost-effectiveness of school oral health prevention program: a case study of community dentistry, Mahidol University

School may be the only place where oral health services are provided for high-risk children with limited access to dental care. We found this to be a common situation in many low-income countries, compounded by a lack of dental personnel. A school oral health prevention program is widely implemented in Thailand; however, the program's cost-effectiveness is under-investigated. This research project evaluated the cost-effectiveness of a comprehensive school oral health program implemented in the academic setting from the provider’s perspective. The retrospective study was conducted using profile data of primary school children in low socioeconomic areas during the academic years 2009–2018 from the Mahidol school oral health program database. The program's effectiveness was measured as DMFT increment scores from the first to the sixth grade between the intervention and control groups. To estimate unit costs for preventive dental services, cost data were collected according to the WHO CostIt program. The total cost was determined based on two elements: recurrent cost and capital cost. The economic costs of the program in the 2015 academic year for first- to sixth-grade children were an average of 1,196,839.37 Baht (34,944.42 USD), comprised of recurrent costs (36.1%) and capital costs (63.9%). Personnel costs and equipment depreciation costs were a major part of recurrent costs and capital costs, respectively. Specifically, capital costs were accountable for more than half of total program costs. The incremental cost-effectiveness ratio (ICER) of the completed 5-year program compared with the control group was 4,035.31 Baht per DMFT avoided. The study findings, which suggested the effectiveness of this program, are useful for its extension and expansion. The cost-effectiveness of the oral prevention program indicated that it is worth implementing, especially for outreach and children of low socioeconomic status at high risk of caries.

The Drinking Water Tool: A Community-Driven Data Visualization Tool for Policy Implementation.

The Drinking Water Tool (DWT) is a community-driven online tool that provides diverse users with information about drinking water sources and threats to drinking water quality and access due to drought. Development of the DWT was guided by the Community Water Center (CWC) as part of the Water Equity Science Shop (WESS), a research partnership integrating elements of community-based participatory research and the European Science Shop model. The WESS engages in scientific projects that inform policy change, advance water justice, and reduce cumulative exposure and disproportionate health burdens among impacted communities in California. WESS researchers conducted qualitative analysis of 15 stakeholder interviews regarding the DWT, including iterative feedback and the stakeholder consultation process as well as stakeholder perceptions of the tool’s impact on California water policy, organizing, and research. Results indicate that the DWT and the stakeholder engagement process which developed it were effective in influencing policy priorities and in promoting interagency coordination at multiple levels to address water equity challenges and their disproportionate burdens, particularly among rural and low socioeconomic status areas and communities of color.

The Family Is My Priority: How Motherhood Frames Participation in Physical Activity in a Group of Mothers Living in a Low Socioeconomic Status Area.

Socioeconomic status (SES) is known to influence strongly both life expectancy and healthy life expectancy. Whilst there are multiple factors with complex interactions that provide the explanation for this observation, differences in the uptake of physical activity between high and low SES groups play a role. This in-depth qualitative study set out to understand the response of a group of mothers with young children living in a low SES area of a London (UK) borough to the current physical activity guidance and to investigate whether existing and established interventions based on behavior change are appropriate for this group. A series of three in depth interviews was carried out with the mothers (n = 20) over a period of 16 months, and the data collected were analyzed thematically. Four main themes were identified: (1) mothering comes before exercise; (2) mothers are a special case; (3) alone or together; and (4) facilities fail mothers. The mothers were unsure about the benefits of exercise, whether it was relevant for them and how to accommodate exercise alongside their mothering responsibilities. Family and peer group could be both a barrier and a facilitator to participation in physical activity. Without an in depth understanding of the role of physical activity in the lives of mothers of young children, behavior change-based public interventions are likely to fail to meet the needs of this group. A reduction in the current health inequities will only be possible when the needs of the mothers are acknowledged and used as the basis of appropriate public health guidance.

Refusal for Dialysis by Acute and Cronic Renal Failiar Patients at Sheikh Ziad Hospital Rahim Yar Khan

Background:- Patients suffering from advanced renal faillairare diagnosed in advanced stages of the disease but acute renal failure patients are diagnosed on early stage. Patients who are admitted in the ward are afraid of hemodialysis. All the patients who were suffering from end stage renal disease or acute renal failier having indications for hemodialysis were enrolled in the study. Patients were asked regarding acceptance or refusal of hemodialysis and the causes of their decisions Socioeconomic, demographic and clinical characteristics of the patients were compared between patients who underwent or refuse for hemodialysis. 150 patients were included in this study. Mean ages of the patients were 42.6 ± 15 years. Of all 99 (66%) patients refuse for dialysis while 51 (34%) patients were agreed for dialysis. Patients with AV fistula (30 Vs. 8 % P 0.021) and those with good socioeconomic background, well-educated group 63.1 vs. 39.4 (P=.031) underwent hemodialysis. Hemodialysis will save lives ( 85% ) was a main cause for accepting this modality. Repeated session for dialysis in remaining life (56.4%), poor quality of life with hemodialysis (39%) and fear of severe pain and complication of needle incursion during hemodialysis (45%) were the most common factors causing refusal of hemodialysis. Treatment with homeopathic and herbal medications was more common cause for refusal of hemodialysis specially patients belongs to remote area and low socioeconomic area Keywords: -End stage renal disease, Chronic Kidney disease, Hemodialysis, Acute kidney injury.

Challenges experienced by community health workers and their motivation to attend a self-management programme.

BackgroundCommunity health workers (CHWs) are change agents expected to assist in decreasing the global burden of disease in the communities they serve. However, they themselves have health risk behaviours, which predispose them to non-communicable diseases and thus need to be empowered to make better health choices. There is a gap in literature detailing the challenges faced by CHWs in addressing their own health risk behaviours.AimThis study aimed to explore the challenges experienced by CHWs in carrying out their daily duties and the motivating factors to join a self-management programme.SettingThe study was conducted in a low socio-economic urban area of the Western Cape, South Africa.MethodsThis study used a qualitative exploratory design using in-depth interviews to obtain rich data about the personal and professional challenges that CHWs experience on a daily basis.ResultsFive themes emerged with regard to professional challenges (social conditions, mental health of patients, work environment, patient adherence and communication). This cadre identified ineffective self-management as a personal challenge and two themes emerged as motivation for participating in a self-management programme: empowerment and widening perspective.ConclusionThe challenges raised by the CHWs have a direct impact on their role in communities. This study therefore highlights an urgent need for policymakers and leaders who plan training programmes to take intentional strategic action to address their health challenges and to consider utilising a self-management intervention model to improve their overall health status.

Perceptions of service quality in Victorian public dental clinics using Google patient reviews.

Objectives Using Google online reviews, this study investigated why patients were satisfied or dissatisfied with their public dental clinic in Victoria, Australia. Methods This mixed methods study gathered Google reviews published by users pre-March, 2021. The reviews were coded and subthemes and major themes were identified. The most common reasons why patients gave reviews were tabulated and stratified according to star rating, remoteness and accessibility index classification, and socio-economic status. Results Of the 522 reviews included in this study, in 317 (60.7%) satisfaction was expressed. Compliments and complaints were documented. A total of 53 subthemes were identified. Major themes included Treatment, Staff, Communication and Professionalism, Patient Factors and Non-Clinical Reasons. From the reviews, more patients were satisfied with general unspecified treatment (n = 195; 14.7%) and dissatisfied with reception staff (n = 64; 4.8%). More reviews were generated by patients who visited clinics in major cities and lower socio-economic areas. Conclusion This study found that most patients expressed satisfaction and identified reasons why patients were satisfied or dissatisfied. Consumer feedback, including compliments and complaints, is an integral aspect of monitoring and improving health service quality. It is important to continue seeking feedback and improve accordingly.

The link between out-of-pocket costs and inequality in specialist care in Australia.

Objective Out-of-pocket (OOP) costs could act as a potential barrier to accessing specialist services, particularly among low-income patients. The aim of this study is to examine the link between OOP costs and socioeconomic inequality in specialist services in Australia. Methods This study is based on population-level data from the Medicare Benefits Schedule of Australia in 2014-15. Three outcomes of specialist care were used: all visits, visits without OOP costs (bulk-billed services), and visits with OOP costs. Logistic and zero-inflated negative binomial regression models were used to examine the association between outcome variables and area-level socioeconomic status after controlling for age, sex, state of residence, and geographic remoteness. The concentration index was used to quantify the extent of inequality. Results Our results indicate that the distribution of specialist visits favoured the people living in wealthier areas of Australia. There was a pro-rich inequality in specialist visits associated with OOP costs. However, the distribution of the visits incurring zero OOP cost was slightly favourable to the people living in lower socioeconomic areas. The pro-poor distribution of visits with zero OOP cost was insufficient to offset the pro-rich distribution among the visits with OOP costs. Conclusions OOP costs for specialist care might partly undermine the equity principle of Medicare in Australia. This presents a challenge to the government on how best to influence the rate and distribution of specialists' services.

"Mother's Health and Well-Being Matters: Is a Mediated Social Cohesion Public Health Intervention Feasible?"

To test the feasibility of introducing 'Free Time for Wellness' (FT4W) an intervention to increase healthy behaviours and reduce the risk of cancer. Feasibility study; Setting: Washington Heights, New York, USA is a low socioeconomic status area. Mothers aged 18 and above with children under 12years of age and living in Washington Heights were recruited. FT4W, a community-based intervention delivered through a neighbourhood-based app, offering weekly dance and yoga classes, food pantry visits and group playdates. Childcare professionals cared for participants' children during wellness activities. A bespoke before and after survey was designed and tested for its ability to collect relevant data to assess the impact of FT4W. Outcomes included recruitment rates, participation, attrition, acceptability, and success of the community champion. Comparisons of proportions and means. Twenty-one mothers participated in the study of which 90% attended ≥ 1 FT4W activity; 65% ≥ 2; 52% ≥ 3. The survey was completed by a 100% of participants indicating it was easy to understand and not too burdensome. All measures detected change in constructs from baseline to follow-up. Availability of childcare was the most commonly (66%) reported reason participants were able to engage in the offered wellness activities. Conducting a larger-scale trial to assess the impact of FT4W is feasible considering 4 major lessons. (1) Recruitment, retention, and acceptability rates were high; however, moms need additional support to increase participation in wellness activities and improve tech literacy. (2) Research measures were sensitive enough to detect change, but the timing of assessments needs to be considered. (3) Participants greatly valued access to professional childcare. (4) The Community Champion is a necessary, but difficult role to fill that requires careful consideration by the Institutional Review Board (IRB).

Are Community Coalitions a Better Mechanism to Advance Health Equity? A Narrative Review

Background/Objective: Despite increasing emphasis on health equity in policy, leadership, and program development, meaningful advancement in health equity remains a challenge. A comprehensive review of community health coalition efforts to improve health equity has not been conducted. In this narrative review, we examine what evidence exists that community health coalitions can advance health equity, and whether coalitions are a preferred approach to address health equity.&#x0D; Methods: PubMed, CINAHL, PsycINFO, and Web of Science were searched for peer-reviewed, English articles with no date restrictions. In total, 1256 records were screened, of which 1163 were excluded for duplicate publications, no coalition or coalition-based intervention, no relevant outcomes, no emphasis on health equity or disparities, not primary literature, or unavailable full text. The remaining 93 articles are presented as a table of interventions based on outcomes. Further, evaluations of coalition effectiveness with controls are reviewed.&#x0D; Results: Populations of interest were racial and ethnic minorities, women and girls, low socioeconomic status communities, rural and urban areas, older adults, and LGBTQ groups. The most commonly reported results were changes in health outcomes or behaviors and community or organizational policy. Few studies were randomized, double-blinded, or controlled trials. This is not unexpected given the difficult nature of evaluating community interventions. Very few studies evaluated the effectiveness of a coalition-based intervention as compared to organizational interventions.&#x0D; Conclusion, Impact, &amp; Implications: Available literature suggests that health coalitions influence health outcomes, policies, and important social determinants of health in populations affected by health inequity. However, community intervention studies pose a unique challenge for high quality evaluation. While health coalitions have a positive influence on health equity, more research is needed to determine the advantages of health coalition interventions versus organizational interventions.

Enabling Better Physical Activity and Screen Time Behaviours for Adolescents from Middle Eastern Backgrounds: Semi-Structured Interviews with Parents.

The unrelenting obesity pandemic in Middle Eastern (ME) adolescents living in Australia warrants culturally responsive and locally engineered interventions. Given the influence of parents on the lifestyle behaviours of adolescents, this qualitative study aimed to capture the opinions of ME parents on the barriers and enablers to sufficient physical activity and limiting screen time behaviours in adolescents. Semi-structured interviews were conducted with 26 ME parents (female) aged 35–59 years old, most of whom resided in lower socioeconomic areas (n = 19). A reflexive thematic analysis using the Theoretical Domains Framework and the Capability, Opportunity, Motivation-Behaviour model was performed for coding. Parents voiced confidence in their knowledge of the importance of physical activity and limiting screen time but were less optimistic in their ability to enable change in behaviours, especially for older adolescents without outside support. Despite adolescents having the necessary skills to engage in a wide array of sports, the parents admitted deep fears regarding the safety of the social environment and restricted their children’s independent mobility. Gender differences were noted, with parents reporting older girls expressing disinterest in sports and having limited physical opportunities to participate in sports at school. It may be that a community-based participatory framework is needed to improve physical activity opportunities and to address specific physical, social, and cultural barriers.

Enabling Better Nutrition for Adolescents from Middle Eastern Backgrounds: Semi-Structured Interviews with Parents.

The unyielding obesity epidemic in adolescents from Middle Eastern (ME) backgrounds warrants culturally-responsive and co-designed prevention measures. This study aimed to capture the opinions of ME parents residing in Australia on the crisis and their enablers and barriers to healthy eating interventions given their influence on adolescent eating behaviors. Twenty-six semi-structured interviews were conducted with ME mothers, aged 35–59 years, and most residing in low socioeconomic areas (n = 19). A reflexive thematic analysis using the Capability, Opportunity, Motivation-Behaviour model and Theoretical Domain Framework was conducted. Parents expressed confidence in knowledge of importance of healthy eating, but were reluctant to believe behaviours were engaged in outside of parental influence. Time management skills are needed to support working mothers and to minimize reliance on nearby fast-food outlets, which was heightened during COVID-19 with home-delivery. Time constraints also meant breakfast skipping was common. A culture of feeding in light of diet acculturation and intergenerational trauma in this diaspora was also acknowledged. Parents pleaded for upstream policy changes across government and school bodies to support parental efforts in the form of increased regulation of fast-food and subsidization of healthy products. Opportunities for weight-inclusive programs including parenting workshops underpinned by culturally-responsive pedagogy were recommended.

Implementing a set of health promoting processes in English secondary schools: A comparative case study

ObjectiveTo understand the enablers and barriers to implementing a set of adaptive processes aimed at supporting secondary schools to reflect on and subsequently address how they could adjust school practices, culture and the environment to create a whole school approach to promoting healthy lifestyles. Study designA qualitative, comparative case study. MethodsTwo in depth case studies were created of two purposefully selected schools in low socio-economic areas of South West England. Data were collected via meetings, observations, field notes, interviews and audit. Interviews were transcribed verbatim. Individual thematic analyses were conducted for each school and a comparative analysis approach was used to understand the barriers and enablers across both cases. ResultsSchools were supported to use a health-promoting lens and identify feasible improvements through an adaptive and context specific process. The school environment and ethos were identified as the areas where schools could conceive the most adjustments to enhance the promotion of healthy lifestyle choices. With the lack of government policy for health promotion in schools (HPS), the Head teacher's approach to health was key to making meaningful changes. ConclusionsHealth promoting school approaches need to be adaptive to local context, actively involve community partners and link to local initiatives where possible, with support from Head teachers and business managers. Starting with what teachers, pupils and parents see as the barriers to health can create a whole school ethos for broad reaching and sustainable HPS programmes.

Cardiac Risk Factors in Black Women With Breast Cancer Undergoing Proton Therapy (PBT): Potential for Increased Therapeutic Gain

Proton therapy remains a scarce resource in the United States, especially for minority citizens who reside in low socioeconomic areas. Breast cancer (BC) often requires adjuvant radiation therapy (RT) and adjuvant RT is associated with increased cardiac events. PBT results in decreased cardiac exposure for BC. Black patients are more likely to present with advanced breast cancer and are at higher risk for additional cardiac comorbidities when compared to other races. Here we report a single institutional experience of BC patients receiving adjuvant proton therapy in an urban environment. We hypothesize that our black BC population undergoing PBT will carry higher rates of cardiac risk factors than other races and thus would be more likely to benefit from the cardiac-sparing dosimetry of PBT.Consecutive BC patients who received proton therapy were retrospectively analyzed under an IRB approval. A variety of demographic and tumor related variables were analyzed using descriptive statistics. Chi-square tests were used to assess associations of categorical variables. Mann-Whitney U test was used to assess significant differences between populations.From February 2016 - December 2020, 343 BC patients received adjuvant proton therapy. With a median follow-up of 13 months (range:0.7-60), black patients comprised 30% of the population (white: 61.8%; other: 8.2%) and were more likely to have triple negative (35.3% vs.16.2%; P = 0.001) and more advanced disease (stage III: 36% vs.24%) when compared to white patients. Black patients had higher rates of diabetes (P = 0.043), hypertension (P < 0.001), hyperlipidemia (P-0.028) and obesity (BMI) (P < 0.001) at time of consultation. Median income was lower for black patients when compared to white patients (P < 0.001) yet there was no difference in insurance coverage between the cohorts. At time of last follow up, 86% of patients had no evidence of recurrence.We report a high percentage of black patients with increased cardiac comorbidities treated with proton therapy as part of their treatment paradigm for BC. Protons have the potential to decrease the risk of long-term cardiovascular events in BC patients, particularly in women who have an increased risk of heart disease, and thus may be particularly beneficial in the black population. Improvements in access to care continues to be important for black and minority populations with BC.

Dental caries prevalence and severity in relation to residential factor among (6-9) years school age children in two different area in Baghdad city

The aim of this study is to estimate the prevalence and severity of dental caries among(6-9) years old children in two different socioeconomic background area in Baghdad city . Dental caries diagnosis was done according to criteria of WHO(1987). The total sample composed of 240 children (120 males and 120 females). Results showed that the prevalence of dental caries for the total sample was 100%, in another word caries free percentage was zero. Result showed that for the primary dentition dmfs and dmft values were higher for males aged 6-7 and 7-8 years in high socioeconomic class (7.8 &amp; 4.2 , 9.7 &amp; 4.7) than in low socioeconomic class (6.7 &amp; 3.9 ,7.2 &amp; 3.2) with statistically no significant differences ( p&gt; 0.05). For children aged 8-9 years in low socioeconomic area the values were higher compared with those in high socioeconomic area for both gender. For the permanent dentition the high social class showed higher prevalence of dental caries compared with their lower social class counter parts except females aged 8-9 years with low socioeconomic status recorded higher DMFS and DMFT values ( 2.66 &amp; 2.6) compared to those in high socioeconomic (2.6 &amp; 1.8), while the relation was not significant ( p&gt;0.05). Generally the present study showed that the prevalence and severity of dental caries for primary teeth was higher among children with low social class (dmfs &amp; dmft) than those with high social class, while the results were reversed for the permanent teeth.